Taking action on the social determinants of health: improving health access for the urban poor in Mongolia

Lhamsuren Khandsuren, Choijiljav Tserendolgor, Budbazar Enkhtuya, Vanchinkhuu Surenchimeg, Blanc Diana, Grundy, Grundy John

Description

In recent years, the country of Mongolia (population 2.8 million) has experienced rapid social changes associated with economic growth, persisting socio-economic inequities and internal migration. In order to improve health access for the urban poor, the Ministry of Health developed a "Reaching Every District" strategy (RED strategy) to deliver an integrated package of key health and social services. The aim of this article is to present findings of an assessment of the implementation of the RED strategy, and, on the basis of this assessment, articulate lessons learned for equitable urban health planning. Methods Principal methods for data collection and analysis included literature review, barrier analysis of health access and in-depth interviews and group discussions with health managers and providers. Findings The main barriers to health access for the urban poor relate to interacting effects of poverty, unhealthy daily living environments, social vulnerability and isolation. Implementation of the RED strategy has resulted in increased health access for the urban poor, as demonstrated by health staff having reached new clients with immunization, family planning and ante-natal care services, and increased civil registrations which enable social service provision. Organizational effects have included improved partnerships for health and increased motivation of the health workforce. Important lessons learned from the early implementation of the RED strategy include the need to form strong partnerships among stakeholders at each level of the health system and in the community, as well as the need to develop a specific financing strategy to address the needs of the very poor. The diverse social context for health in an urban poor setting calls for a decentralized planning and partnership strategy, but with central level commitment towards policy guidance and financing of pro-poor urban health strategies. Conclusions Lessons from Mongolia mirror other international studies which point to the need to measure and take action on the social determinants of health at the local area level in order to adequately reduce persistent inequities in health care access for the urban poor.

Sujets

• Mongolia

Informations

• Publié par: biomed
• Publié le: 01 janvier 2012
• Nombre de lectures: 6
• Langue: English

Extrait

Lhamsurenet al.International Journal for Equity in Health2012,11:15 http://www.equityhealthj.com/content/11/1/15

R E S E A R C HOpen Access Taking action on the social determinants of health: improving health access for the urban poor in Mongolia 1 23 4 Khandsuren Lhamsuren , Tserendolgor Choijiljav , Enkhtuya Budbazar , Surenchimeg Vanchinkhuu , 5 6* Diana Chang Blanc and John Grundy

Abstract Introduction:In recent years, the country of Mongolia (population 2.8 million) has experienced rapid social changes associated with economic growth, persisting socioeconomic inequities and internal migration. In order to improve health access for the urban poor, the Ministry of Health developed a“Reaching Every District”strategy (RED strategy) to deliver an integrated package of key health and social services. The aim of this article is to present findings of an assessment of the implementation of the RED strategy, and, on the basis of this assessment, articulate lessons learned for equitable urban health planning. Methods:Principal methods for data collection and analysis included literature review, barrier analysis of health access and indepth interviews and group discussions with health managers and providers. Findings:The main barriers to health access for the urban poor relate to interacting effects of poverty, unhealthy daily living environments, social vulnerability and isolation. Implementation of the RED strategy has resulted in increased health access for the urban poor, as demonstrated by health staff having reached new clients with immunization, family planning and antenatal care services, and increased civil registrations which enable social service provision. Organizational effects have included improved partnerships for health and increased motivation of the health workforce. Important lessons learned from the early implementation of the RED strategy include the need to form strong partnerships among stakeholders at each level of the health system and in the community, as well as the need to develop a specific financing strategy to address the needs of the very poor. The diverse social context for health in an urban poor setting calls for a decentralized planning and partnership strategy, but with central level commitment towards policy guidance and financing of propoor urban health strategies. Conclusions:Lessons from Mongolia mirror other international studies which point to the need to measure and take action on the social determinants of health at the local area level in order to adequately reduce persistent inequities in health care access for the urban poor. Keywords:Health Inequities, Urban Health, Health System Strengthening, Mongolia, Reaching Every District

Background The international context for health inequities There are increasing reports of the public health signifi cance of inequities in health access and outcomes. Inequity in health has been conceptualized as a“mea sure of difference”in access or outcomes based on social

* Correspondence: [e-mail] 6 Public Health Consultant, Nossal Institute for Global Health, The University of Melbourne, Cambodia Office, Phnom Penh, Cambodia Full list of author information is available at the end of the article

or economic exposures such as wealth, education level and location of residence. One analysis of equity and trends in coverage of maternal, newborn, and child health services in 54 countries between the years 1990 and 2006 found that,“in general, incountry patterns of inequality are persistent and change only gradually if at all”[1]. Many studies have indicated that these inequi ties are socially determined. That is, social exposures such as education, income level and rural residence are the best predictors of health service access and health

© 2012 Lhamsuren et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.